Mr Prime Minister, It’s Time to Resign
Dear Prime Minister Boris Johnson,
55,000 people have died from COVID-19 since Christmas, a mere 12 weeks ago. The official UK death toll has now surpassed 125,000 people but is likely to be much closer to 150,000 deaths – more than 3x the number of civilians killed in the Blitz. We now boast the second highest COVID-19 death rate on the planet, worse than Trump’s America and Bolsonaro’s Brazil. The UK economy is enduring its greatest contraction in over 300 years, with a shocking 10% drop in GDP over the last year. Now that we have made it through the worst of the second wave, it’s now time to be direct with you: You placed the nation’s wealth over the nation’s health, saved neither, and it is now time for you and your health secretary to resign.
Thank you for your efforts to craft a comprehensive plan to emerge from lockdown and to ensure the nation is vaccinated. History will record the NHS vaccine rollout as a great success during this dark period.
But after what our patients experienced in January, after what we doctors, nurses, and allied health professionals witnessed during the worst of the second wave, nothing you can do now will erase your record of negligence that led to these 55,000 deaths since Christmas and the 70,000 people who perished before them.
Mr Johnson, to see why such a request is entirely warranted and indeed necessary, you need to understand your party’s devastating role in the decline of the nation’s health before the pandemic, the negligent policy failures that led to these deaths, what we in the NHS experienced on the front lines of your man-made disaster, and what the health service can expect in the aftermath of your COVID-19 failures.
THE NHS BEFORE THE PANDEMIC
The Conservatives have been responsible for NHS policy since 2010 and in that time the health of the nation has experienced a significant decline, such that average life expectancy dropped for the first time in over 100 years. Conservative policies, the evidence suggests, are bad for the nation’s health.
This is not partisan hyperbole but fact: For too many years, we have had too few hospital beds, not enough staff, and a social care system not fit for purpose. Your party has overseen the loss of 17,000 hospital beds since 2010, not done enough to address staff shortages of 100,000 doctors, nurses, and other critical NHS staff, failed to fix a broken social care system that has its own 120,000 vacancies, delayed transfers of care costing the NHS £640,000 a day, and forced far too many people to sell their homes to put a loved one in care.
These problems are the result of successive Conservative governments refusing to listen to clinicians and policy experts who have begged the government over the last decade to craft policy remedies and supply annual funding increases necessary to maintain a world-class health service here in the fifth wealthiest country on earth.
The results were devastating but entirely expected: worsening winter crises, a demoralised and undervalued workforce, the worst A&E and cancer waiting times in NHS history, and the alarming fall in life expectancy.
Prior to COVID-19, the state of the NHS was anything but strong, due in very large part to Conservative mismanagement for nearly a decade.
A DECADE OF NEGLIGENT PANDEMIC PLANNING
But when it comes to pandemic preparedness, your party’s record is not just bad, it is a master class in government negligence.
Ten years ago, the Conservatives pushed the disastrous Health and Social Care Act through Parliament despite united opposition from all of the Royal Colleges and the British Medical Association. It was among the most significant restructurings of the NHS since its creation and among many other bureaucratic changes, it replaced the Health Protection Agency — praised by the World Health Organization as among the best in the world for its preparedness during the 2009 H1N1 Swine Flu — with a new body: Public Health England. While that name sounds lovely, the new organisation worried public health experts who presciently warned the government in 2011 that it was a dangerous policy shift.
Public Health Consultant Dr Alison Merry warned Parliament that the Health and Social Care Act would “fragment, weaken and ultimately destroy the specialty of public health”. Public health official Anna Lynch warned Parliament “the public will be less safe at times of outbreak or pandemic.” Public Health Consultant Dr Hilary Pickles warned Parliament: “When the next pandemic strikes … expect public health systems to be in disarray”.
The Nuffield Trust’s Nigel Edwards called it “the biggest public policy disaster … of the last 20 years”. Your health secretary Andrew Lansley, the architect of the reforms, called the British Medical Association ‘politically poisoned’ for opposing the legislation.
And yet, just a few years later your party would admit the legislation was a massive mistake, with Theresa May even adding that “it is too bureaucratic, inhibits joined-up care, and takes money and people away from the front line.”
But of course, at the time, your party chose to ignore expert medical and public health advice, in what would become a running theme of the Conservatives’ time in power.
And then five years ago, it got even worse. The Conservative government held a nationwide pandemic simulation called “Operation Cygnus” with over 1,000 officials from across the country for an exercise designed to test and expose flaws in our preparedness for a future pandemic. It correctly predicted the horrors we’ve seen during COVID-19 — doing what it was designed to do — but your predecessors and your government then buried the report and failed to implement the recommendations.
The “Operation Cygnus” simulation identified so much of what we clinicians would subsequently experience during COVID-19: PPE shortages, a lack of ventilators, insufficient critical care beds, care home deaths, and an NHS that collapsed under the weight of hundreds of thousands of excess deaths.
Shockingly, despite such a pandemic being at the top of official threats facing the UK for years, neither you nor any of your predecessors — or their health secretaries from Jeremy Hunt to Matt Hancock — ever implemented any of the most critical Operation Cygnus recommendations.
Mr Prime Minister, tens of thousands of people are dead, including nearly 1,000 of my front line colleagues, because successive Conservative governments — yours included — failed to implement these recommendations from the Cygnus simulation. That’s negligence.
But your record of pandemic preparedness gets even worse. Nearly two years ago — six months before the pandemic hit — you scrapped the cabinet level pandemic-response “Threats, Hazards, Resilience and Contingency Committee” to instead focus your energies on Brexit. Such a committee could have helped the government focus their response at the beginning of the pandemic and saved countless lives, but you decided other issues were more important.
Mr Prime Minister, these three failures of pushing through legislation that went against the advice of all of the Royal Colleges and experts in public health despite warnings it would make fighting a pandemic significantly more difficult, hosting a pandemic simulation and then burying the results and recommendations, and then scrapping a cabinet-level pandemic response committee six months before the pandemic, all represent gross negligence of the worst possible kind. As a result, tens of thousands of people died.
For a country once seen as a global leader in pandemic preparation, it is shocking to see just how ill-prepared the Conservatives had allowed the nation to become on the eve of COVID-19. After a decade in 10 Downing Street, talk about failing to fix the roof when the sun was shining.
UNPARALLELED PANDEMIC FAILURES
When we reached the horrific milestone of 100,000 UK deaths from COVID-19, you claimed “we did everything we could” to minimise the loss of life. I assure you that history will record this period very, very differently.
Mr Johnson, you failed to attend the first five COVID-19 national security Cobra meetings one year ago. A senior conservative source told the Sunday Times “there was a real sense that [you] didn’t do urgent crisis planning … it was exactly like people feared [you] would be … there’s no way you’re at war if your PM isn’t there.”
You wasted five weeks of precious preparation time while you sorted out your divorces — both personal and Brexit. You failed to join an EU programme to source PPE, claiming later that you never got the email. You continued to shake hands on hospital wards when SAGE advised against it and refused to set an example and wear a mask in public until July 2020, a full 3.5 months after we first locked down. Leaders must lead by example and you failed this test over and over again.
As NHS bosses became worried about PPE shortages, as Italy and Spain had already closed their schools, as Ireland cancelled St Patrick’s Day celebrations, and France banned large events, your government continued to claim there was “no rationale” for similar measures, and allowed Six Nations rugby matches to continue, the Cheltenham horse racing festival to proceed, and thousands of Atletico Madrid fans to travel to Liverpool. Each was a super spreader event.
In the days after the World Health Organization officially declared COVID-19 a pandemic on 11 March 2020 — one year ago this week — you stopped testing the public, and your government surrendered to the enemy and chose to adopt a strategy of herd immunity, eschewing long-established public health advice from around the world.
Your actions hastened the infection rate as you allowed 18 million air travellers to flow into the country unchecked before the first lockdown, downgraded PPE guidance because your government failed to stock an adequate supply, you continued to allow large events to take place, pubs and restaurants to remain open, and schools to continue operating long after many European neighbours closed theirs.
You then entered lockdown two weeks after Italy, 1.5 weeks after Ireland, and a week after Spain, even though you knew the horrors that we were about to face.
Subsequent analysis would show that 21,000 deaths would have been prevented had you locked down just one week earlier and you finally reversed course on your herd immunity strategy of surrender only after projections estimated 250,000 deaths as a consequence of that policy.
But one of the most heartbreaking errors your government made was to have us discharge elderly patients back into care homes — even if they tested positive for COVID-19 — sometimes without oxygen, without palliation, and without PPE for our care home staff.
A London Cardiologist said ”we actively seeded this into the very population that was most vulnerable.” Health Secretary Matt Hancock would subsequently lie about this, claiming the government had put a “protective ring” around our care homes. He most certainly did not.
As a consequence of your failures, as many as 30,000 members of the Greatest Generation, the Silent Generation, and the Baby Boomer generation then died in care homes gasping for air, without family, without adequate nursing or palliative care, without hope, abandoned by your “One Nation” Conservative government.
Your master class in government negligence continued when you had the chutzpah to defend Dominic Cummings’ absurd trip to Barnard Castle to test his eyesight with his family in the car. In subsequent public opinion polls, many cited that issue as their reason for being non-compliant with lockdown rules.
A fish rots from the head, Mr Prime Minister.
Then the PPE shortages became even more acute. The BBC reported on NHS workers being forced to wear bin bags weeks before your government admitted it was running out of protective equipment. It then became clear that Matt Hancock had ignored the pleas of UK manufacturers to produce PPE while international supply chains collapsed. Hancock would later be found to have broken the law as he offered PPE contracts worth billions to Tory party donors and friends. This corruption alone should warrant its own judge-led inquiry and Mr Hancock’s resignation.
Mr Hancock’s latest attempts to rewrite history and insist that we never ran out of PPE are simply not true and are beyond insulting. Your government ran out of WHO-recommended PPE and told us a simple surgical mask would suffice.
We repeatedly saw coughing COVID-19 patients in rooms with no ventilation simply wearing regular surgical masks, useless plastic gowns that left our bare arms exposed to our patient’s warm coughs, and with 11-year-old shoddy eye protection that fell off our faces and was subsequently recalled as not meeting any acceptable current UK safety standards.
The effect of downgrading PPE guidance, providing us with inadequate PPE, and forcing some of us to use bin liners for protection, was the deaths of nearly 900 of my NHS brothers and sisters who died fighting the virus. We will never forget them and never stop fighting for them.
Subsequent research by the British Medical Association, based on data from the first wave of the pandemic, showed that black, asian, and minority ethnic (BAME) healthcare workers in England were significantly more likely to die from Coronavirus.
The deceit of your health secretary Matt Hancock continued as he lied about testing figures, gave a horse-racing friend Dido Harding the reins of the outsourced Test and Trace programme, and opted to ignore advice about building a contact tracing app using available and more secure tools from Google and Apple. The original app had to be scrapped at huge cost in mid-June, and after spending another £25 million, by mid October it had sent just a single alert about an outbreak in a venue despite being downloaded 16 million times. The failure of the Test and Trace system and contact tracing app contributed to the dramatic rise in cases requiring a second national lockdown. Unsurprisingly, there were justified calls from even Tory MPs for Dido Harding to resign.
Your Chancellor Rishi Sunak’s “Eat Out To Help Out” scheme, which encouraged people to dine in unsafe environments, was also a driving factor that led to increased cases before the second lockdown.
Eat Out to Help Out was criticised by the Institute for Government as “epidemiologically illiterate”, and a University of Warwick study would later link up to 17% of new COVID-19 cases to this poorly designed government initiative.
Your government then subjected working class people to far greater scrutiny and bureaucratic red tape for a one-off £500 self-isolation payment to help them put food on the table whilst ill with COVID-19, than they did for PPE contracts worth billions that were handed out to anyone with Matt Hancock’s WhatsApp number.
The Scientific Advisory Group for Emergencies (SAGE) warned you in September that only 20% of those told to self-isolate actually did so, and despite evidence that it was a smart policy to pay people to isolate when they otherwise couldn’t afford to take the time off, we eventually learned that 70% of those seeking self-isolation benefits were rejected by the government. People who had no choice but to work through their illness to feed themselves and their families simply continued to spread the virus because you failed to craft a policy solution that worked.
Mr Prime Minister, you and your health secretary then decided to axe Public Health England — in the middle of the pandemic.
This is the very same agency that Public Health experts, all of the Royal Colleges, and the British Medical Association jointly warned the Conservatives about implementing ten years ago in the Health and Social Care act. While it surely needed reform, making this move during the pandemic, without having have a proper government inquiry, was yet another dangerous and frivolous idea that was roundly criticised. But once again, your government knew better than to trust the experts.
As the summer stretched into autumn, workers were pressured into returning to unsafe offices fearing that their employer could sack them. Few had faith in Education Secretary Gavin Williamson to safely reopen schools, and the government continued to downplay fears of teachers, parents, and students. Your government still had a poorly designed border policy which allowed anyone to bring the virus into the country and you still hadn’t widely published any guidance on ventilation of indoor spaces.
And then viruses do what viruses do — they mutate.
The B117 Kent Variant — its very existence a sign that the UK government failed to control the spread of the virus — proved to be up to twice as deadly as previous variants and easily worked its way throughout the country and across the globe, where it is now predicted to become the most dominant strain worldwide.
We would later learn that Dido Harding’s ‘NHS’ Test and Trace, tasked to monitor the spread of the disease and ensure we never have to go into another lockdown — and which was given a massive £37 billion over two years with some consultants paid over £6,600 a day — had made “no clear impact”.
The Chairwoman of the cross-party spending watchdog said “the promise on which this huge expense was justified — avoiding another lockdown — has been broken, twice.”
Unsurprisingly, infections rose dramatically across the country in the middle of December and when they soared out of control yet again, you cancelled Christmas and we entered our third national lockdown, again too late.
A report by the Resolution Foundation found that by delaying the third national lockdown, another 27,000 people died.
Lastly, in times of crisis, the Prime Minister must be the comforter-in-chief and you have failed in that role as well. Your constant refusal to meet with the COVID-19 Bereaved Families for Justice is a profound act of cowardice and you should be ashamed of yourself for refusing to meet with them. After all of the difficult conversations that we as junior doctors have had with patients and their loved ones over the last year, it’s incredibly insulting. Mr Prime Minister, you are a coward.
Mr Prime Minister, your government’s policy failures led directly to a second wave of the pandemic that was far worse than the first and caused the preventable deaths of another 55,000 human beings since Christmas, bringing the total to a tragic 125,000 dead, the worst death rate of any large country on the planet.
But if all of these policy failures are not enough to convince you and your supporters that your time as Prime Minister and Health Secretary should be coming to an end, you need to understand what life was like for those of us on the front lines inside the NHS.
WITNESSING THE NHS BREAK APART
Mr Prime Minister, while most were experiencing the misery of a necessary third national lockdown away from their friends and family, those of us working in NHS hospitals were experiencing horror, caused directly by your poor policy decisions and leadership failures.
From the inside, it was no longer a question: January was the month our beloved NHS had finally broken.
At the peak of the second wave, we were caring for nearly twice the number of COVID-19 patients in hospital than at the same point during the first wave last year. Across London, our oxygen was in short supply and the low pressure alarms sounded on our wards.
Mr Prime Minister, Mr Health Secretary, our hospitals felt like war zones because of you.
As had happened during the first wave last year, admission criteria for intensive care and high-dependency units had necessarily become so high that care was rationed and many patients who otherwise would have received an extra shot at life — albeit remote — were routinely denied that opportunity across the country. We simply didn’t have the intensive care beds, the invasive and non-invasive ventilators, or the nursing staff to handle the record numbers of unwell patients.
We have to live with the moral injury of being unable to save these patients, but that guilt should rest firmly on your government’s shoulders.
We knew for years that the UK had among the lowest numbers of ICU beds in all of Europe, among the fewest ICU nurses, and a ventilator capacity that was woefully insufficient for a pandemic surge. Operation Cygnus proved you knew about these failures, and yet you did nothing about it.
Mr Prime Minister, we saw our extraordinary ICU nurses managing multiple patients at once when the global standard of safety is one nurse for a single ICU patient. They managed multiple drug infusions, recorded hourly observations measuring some 30 different parameters, maintained kidney dialysis machines, suctioned secretions, monitored catheters, cleaned dirty nappies filled with faeces, washed the heavy limp bodies of sedated patients, repositioned them to prevent pressure sores, and ran blood samples to our blood gas analysers to ensure their patients were stable.
These nurses are some of the heroes of this pandemic, on their feet for the vast majority of their 12-hour shifts, and are deserving of a hell of a lot more than your performative rounds of applause and an insulting 1% pay rise.
We saw our extraordinary Acute Medicine consultants — some of whom are approaching retirement themselves — come to work at 6:45am, do a non-stop ward round all day with barely 20 minutes for a lunch break, and then go home at 10:30pm feeling guilty they couldn’t see any more patients.
We saw our extraordinary London Ambulance Service paramedics so overwhelmed with record numbers of calls that patient’s families, desperate for an unavailable ambulance, drove their loved ones to hospital, and in some cases, witnessed them have a cardiac arrest in the passenger seat en route.
We started CPR in the car park but by then it was too late. The patient was dead. I can still hear the wails of their family members knowing they have to explain to their young children that daddy isn’t coming home.
We saw a nurse who lost four family members and countless patients during the pandemic still find the strength to come in and serve the NHS in its time of need.
We saw colleagues still exhausted from their own battles with the virus struggle to make it through the day, but we all just pressed on.
We delivered far too many dreaded phone calls to families in the middle of the night. We played patients’ favourite songs to them as they took their final breaths. We said goodbye to husbands and wives within hours of one another on one day, and then signed the death certificates of mothers and their children the next. We took care of colleagues’ parents and shared their grief when they passed away.
After witnessing our patients die in record numbers, so many of us — myself included — showed signs of severe burnout and PTSD. Junior doctors barely out of medical school learned at too young an age what the thousand yard stare looks like.
We saw too many tears in the eyes of our masked colleagues passing us in the hallways. We stopped asking “are you okay?” knowing that none of us were. Instead we just tapped feet, told them to hang in there, and said we’ll see each other “on the other side of the war.”
Mr Prime Minister, Mr Health Secretary, after experiencing the worst of the second wave in person, and witnessing the effect of your government’s failures right in front of our eyes, you must now accept responsibility for this historic failure and step down from government.
If you or your supporters still disagree then let’s have a look at what the other side of the war and the resumption of “normal” NHS services is going to look like. As we emerge from COVID-19, a monumental challenge stands before us. If your budget is any indication, your government still does not fully comprehend the magnitude of damage that your party has inflicted upon the NHS.
AFTER THE PANDEMIC
We entered the pandemic after a 10-year Conservative assault on the NHS that destroyed the resilience of the health service, leaving us in a terrible state on the eve of COVID-19. To make matters much worse, your government was woefully ill-prepared for this crisis, made shockingly poor decisions at multiple inflection points, and the knock-on effects of COVID-19 on our struggling health service will echo for many years to come.
We will be treating up to 1 million new patients with “Long Covid”. Our already overburdened and under-resourced mental health service is under extraordinary pressure as we treat the effects of grief, isolation, depression, anxiety, and stress on a population level not seen since World War II.
Among our children the effects are even more alarming. Mental health charities are reporting a 70% increase in paediatric psychological referrals, the NHS is seeing a 46% increase in paediatric referrals for eating disorders, and data from the UCL Millennium Cohort Study indicates that a massive 24% of children surveyed reported self-harming in the last year, along with 7% who reported attempting suicide. These are terrifying figures.
Moreover, the backlog of cancelled elective procedures, surgeries, cancer screenings, and diagnostic tests will take us years to get through, and tragically, many more people will die prematurely while they wait.
The British Medical Association reported that 2.7 million elective procedures and nearly 19 million outpatient appointments were cancelled last year as a consequence of COVID-19. The British Heart Foundation estimated that nearly 100,000 heart surgeries and procedures were cancelled. Macmillan Cancer Support estimates that 50,000 cancer diagnoses were missed. Breast Cancer Now estimates that up to 11,000 people across the UK are living with undiagnosed breast cancer due to these diagnostic delays. Alarmingly, these estimates are based on data released before the shock of the second wave. It is fair to say that these numbers have all worsened in the last four months.
And despite your government’s demands that non-COVID-19 services continue during the second wave, that simply wasn’t possible. An already overwhelmed system had broken, and with any pre-pandemic resilience already exhausted, it is not surprising that urgent cancer surgeries were cancelled at multiple major London hospitals, why we’ve now hit a 12-year-high for the number of patients on NHS waiting lists, and why the ultimate death toll from your failure to control this virus will be far greater than the 125,000 people who have officially died thus far.
Mr Prime Minister, Mr Health Secretary, it is now time to accept that you have done irreparable damage to this nation’s health and for this, you both must resign.
MR PRIME MINISTER, IT’S TIME TO GO
Mr Johnson, at the beginning of the pandemic last March, the National Medical Director of NHS England Professor Stephen Powis said correctly that “If we can keep deaths below 20,000 we will have done very well in this epidemic.”
By that measure, your administration has failed catastrophically. With the helping hand of your negligent government, 125,000 mothers, fathers, sons, daughters, brothers, sisters, grandparents, colleagues, and neighbours have now died from the virus.
None of this was inevitable. David Cameron’s government failed to listen to medical and health policy experts who implored them a decade ago that the Health and Social Care act would harm us during a pandemic. Theresa May and Jeremy Hunt failed to implement any recommendations after Operation Cygnus predicted 250,000 excess deaths, shortages of PPE, critical care beds, and care home deaths. Your government then scrapped a cabinet-level pandemic response committee 6 months before the pandemic. But then you ignored well-established public health advice and surrendered to the virus by attempting to adopt herd immunity, hoping we could just “take it on the chin.” You failed to be honest about your government’s level of preparedness, failed to prevent infections coming in from abroad, failed to lead by example by shaking hands and not wearing a mask, failed to provide us with adequate PPE, failed to be transparent and not corrupt by giving PPE contracts worth billions to friends and donors without any experience, failed to protect up to 30,000 of our grandparents in care homes, failed to be honest about testing figures, failed to implement a Test and Trace programme to prevent lockdowns, not once, but twice, despite an infusion of £37 billion into the effort, and we all spent a Christmas away from our loved ones because your government prioritised the economy over public health, and failed yet again.
Mr Prime Minister, a recent editorial in the British Medical Journal called the government’s response to the pandemic “social murder”. With 125,000 people dead on your watch, it’s time to go.
But before you leave, do us one favour: immediately launch a judge-led statutory national inquiry into these 125,000 tragic and preventable deaths so that this country, our patients, and my colleagues and I may learn the lessons from this experience and never again have to endure the horrors we witnessed over the last few months. With that act, you will finally do something that you have repeatedly failed to do during your premiership — learn from your mistakes.
Mr Prime Minister, Mr Health Secretary, you placed the nation’s wealth over the nation’s health, and saved neither. May future generations never make the same mistake. It’s time to do the right thing, and step down.
Dr Andrew Meyerson is a junior doctor, writer, photographer, and app developer working in London. A fierce defender of the National Health Service (NHS), he has written about health policy and politics in the Guardian, the Independent, and the Mirror. His views are his own.
